In a case of Niruddha-Prakasá (constriction or stricture of the urethra, a tube (open at both ends) made of iron, wood, or shellac should be lubricated with clarified butter and gently introduced into the urethra. The marrow or lard of a boar, or of a porpoise, or the Chakra-taila, mixed with Váyu-subduing drugs should be sprinkled over the affected part. Thicker and thicker tubes should be duly introduced into the urethra every third day. The passage should be made to dilate in the aforesaid manner, and emollient food should be given to the patient. As an alternative, an incision should be made (into the lower part of the penis), avoiding the sevani (raphe of the perineum) and it should be treated as an incidental ulcer Sadyo-vrana 26.
Cases of Sanniruddha-Guda (stricture of the anus), Valmika and Agni-Rohini should be duly treated with regard to the nature and intensity (of the Doshas engendering the disease , but without holding out any definite hope of recovery. The treatment of a case of Agni-Rohini should be like that of Visarpa (Erysipelas), while the remedial measures, mentioned in connection with Niruddha-prakas'a, should be employed in a case of Sanniruddha-Guda. 27.
The diseased patches should be scraped off in a case of Valmika and cauterised with fire or with an alkali; while the purification and healing up (of the incidental ulcer) should be effected as in the treatment of an Arvuda (tumour;. A case of Valmika appearing in any part of the body other than a Marma, and not of a considerable growth should be duly treated with venesection after the application of Sams'odhana measures (purgative, emetic, etc.;. The affected part should be plastered (Pralepa) with a medicinal compound composed of the roots of (Vana) Kulattha, Arevata, Danti and S'yámá, pasted together with Guducht, reck-salt, Palala (pastes of sesa-mum) and powdered barley. It should be poulticed (Upanáha) with the same compound, well mixed with clarified butter and made lukewarm (in case suppuration be desired). When found to be fully suppurated, the course of the pus-channels should be ascertained by an experienced surgeon. The ulcer should then be opened (with a knife) and cauterised, and after being fully purified of the putrid flesh (in its cavity), it should be again cauterised with an alkali. Healing (Ropana) remedies should be applied to it after it has been found to be thoroughly cleansed Nimba-oil cooked with Sutnanas (Játi leaves, Granthi, Bhallá-taka, Manahs'ilá, Kalánusári, small Elá, A guru and red Chandana should be applied with advantage to heal up the incidental ulcer in a case of) Valmika. A patient suffering from an attack of Valmika appearing either on his hands or feet and attended with swelling and a large number of cavities should be abandoned by a wise physician. 28.
In the treatment of an infant laid up with an attack of Ahi putaná the breast-milk of its mother or nurse should be first purified. Cases of Ahi-putaná yield to the use of a potion of clarified butter, cooked with Triphalá, Rasán-jana and Patola leaves, and a decoction of Triphalá, Kola and Khadira should be used (as a wash) to heal the ulcer. Plasters composed of sulphate of iron, Goro-chaná, sulphate of copper (Tuttha), Haritála and Rasán-jana, pasted together with Kánjika, or of Vadari bark and rock-salt, should be applied (to the diseased locality . It should be dusted as well with the pulverised compound of a burnt earthen pot and sulphate of copper. The preceding measures should be adopted in cases of Vrishana-Kachchhu as well. 29-30.
Treatment of Guda-Bhramsa: in a case of Guda-Bhrams'a the protruded part should be fomented and lubricated with Sneha.* It should then be gently re-introduced. The region of the anus should then be bandaged with a piece of hide in the manner of a Gophaná Bandha, with an opening in it (lying imme diately below the anus), so that it may not in any way interfere with the emission of Váyu. The affected part should then be constantly fomented. A quantity of milk, Mahá-pancha-mula and the body (flesh) of a mouse, bereft of its entrails should be first boiled together (with water). An oil cooked with the milk thus prepared (with water) and the Váyu-subduing drugs should be administered as drink and unguents. By these measures the most difficult cases of prolapsus ani would be cured. 31-32.
* According to S'iva-dasa, cow's fat only should be used.
Thus ends the twentieth Chapter of the Chikitsita Sthanam in the Sus'ruta Sambita which deals with the treatment of minor ailments.